Brain Injury review

This abstract is taken from the Edwards and Tan paper in Current opinion in pediatrics.

PURPOSE OF REVIEW: The association between perinatal infection and brain injury is widely accepted but a cause-and-effect relationship has not yet been proven. This article summarizes available evidence and current primary publications for debate.

RECENT FINDINGS: Work completed during the review period has reinforced current understanding of perinatal infection, prematurity and brain injury. In animal experiments: lipopolysaccharides have been further implicated in brain injury, not only as a cause of brain injury but also as mediators of preconditioning and protection. Recent studies suggest that cerebral injury following low-dose lipopolysaccharide administration may become compensated in adulthood. Other studies have emphasized the complexity of the response by showing that plasma cytokine levels may not reflect those in the central nervous system or inflammatory events in the brain.

SUMMARY: Perinatal infection and maternofetal inflammation is strongly associated with preterm birth. Inflammation probably represents an important mechanism for cerebral damage, and both overt lesions and maldevelopment can result. Epidemiological data and multiple animal models to link infection, inflammation and brain damage exist, but proof of causation is elusive.

If you are intersted in the full article it can be found under the pubmed ID 16601489

This Abstract is taken from the Journal of International Medical Reserch (2006 Jan-Feb;34(1):58-64.) and is by Liu et al, in the Wang group at the Department of Neurosurgery at Zhejiang University, China.

The Abstract is as follows

We prospectively investigated non-invasive selective brain cooling (SBC) in patients with severe traumatic brain injury. Sixty-six in-patients were randomized into three groups. In one group, brain temperature was maintained at 33 - 35 degrees C by cooling the head and neck (SBC); in a second group, mild systemic hypothermia (MSH; rectal temperature 33 - 35 degrees C) was produced with a cooling blanket; and a control group was not exposed to hypothermia. Natural rewarming began after 3 days. Mean intracranial pressure 24, 48 or 72 h after injury was significantly lower in the SBC group than in the control group. Mean serum superoxide dismutase levels on Days 3 and 7 after injury in the SBC and MSH groups were significantly higher than in the control group. The percentage of patients with a good neurological outcome 2 years after injury was 72.7%, 57.1% and 34.8% in the SBC, MSH and control groups, respectively. Complications were managed without severe sequelae. Non-invasive SBC was safe and effective.

If you are interested in the full article the Pubmed Identification is 16604824

This study into the severity of head injuries in children in Kashmere was carried out by tabish et al. below is the abstract I’m sure that you’ll find it interesting.

A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries.

The collection of the results was carried out a few years ago. 

In 2003, a prospective study of all children below 15 years admitted to hospitals with a diagnosis of head injury was conducted in the Accident & Emergency Department of Sher-e-Kashmir Institute of Medical Sciences, Srinagar (India) to determine the incidence and severity of accidental head injury among children and the circumstances of injury.

The highest incidence of head injury was seen at ages 6-10 years. Head injury rates were higher in males than in females. The leading causes include falls and motor vehicle accidents. More than 50% falls occurred in the age group of 4-6 years. Ninety per cent patients, who recovered, were discharged within 16-24h after admission. Lack of supervision, non-implementation of safety measures and poor implementation of traffic rules leads to many injuries.

It is likely that these patients will be hard to look after due to cost restraints! 

The ability of the health care system to deal with increasing trauma in Jammu & Kashmir is limited. Nevertheless, prevention can be low cost strategy to overcome this problem.

The results of epidemiological studies are affected by factors like demography, geographic region and socioeconomic status. This study emphasizes the need for intensified effort for prevention, minimising risk factors, strict legislative measures, observing traffic rules, implementation of safety measures, establishing appropriate trauma care at district level, adult supervision, and creating awareness.

Pubmed ID 16569405

Full text at Science direct http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T78-4JKHPCN-2&_coverDate=05%2F31%2F2006&_alid=389394347&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5052&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1cc3f5c8407eaa385cf49900df02e28c

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